Objectives: This study evaluated the prevalence of central venous access port device (CVPAD)-related venous thrombosis in colorectal cancer patients requiring chemotherapy and its relationship with clinical factors.

Methods: At Niigata City General Hospital, 282 patients with colorectal cancer underwent CVPAD placement before chemotherapy between January 2010 and December 2019. The relationships between venous thrombosis and clinical factors, including age, sex, drug use, indwelling site, insertion time and experience of the surgeon, were analyzed.

Results: Seventeen patients (6.0%) had CVPAD-related venous thrombosis. The median duration for thrombosis related to totally implantable CVPADs was 6.6 (1.3-59.4) months. CVPADs were removed in all patients with thrombosis. The frequency of CVPAD-related venous thrombosis was affected by sex (P = 0.019). Regarding indwelling sites, there was no significant association between the occurrence of venous thrombosis and the left subclavian or jugular vein approach (P = 0.084).

Conclusion: CVPAD-related venous thrombosis may require CVPAD removal and a change in the treatment schedule for colorectal cancers. It is important to avoid the left subclavian and jugular vein approach of CVPAD.

The study included 2,221 patients who underwent colonoscopy for the evaluation of a positive FIT (group A), 1,783 for asymptomatic direct screening (group B), and 2,254 for diagnosis with clinical symptoms (group C). A total of 1,071 adenomas and/or intramucosal cancers in 650 patients (29.2%) in group A, 572 in 337 (18.9%) in group B, and 434 in 283 (12.6%) in group C were detected, respectively. A comparison between groups A, B, and C revealed that the intramucosal lesions detected in group A were characterized by their left-sided location (p < 0.001), polypoid appearance (p < 0.05), and more-advanced histology (p < 0.05) as compared with those in group B. A total of 115 invasive cancers in 115 patients (5.2%) in group A, 28 in 28 (1.6%) in group B, and 309 in 303 (13.3%) in group C were detected. The invasive cancers detected in group A were characterized by their smaller size (p < 0.001), shallower depth (p < 0.001), and lower LN involvement (p < 0.005) as compared with those in group C.

FIT-positive colonoscopy detected a higher amount of adenomas and intramucosal cancers with advanced histology and also effectively detected invasive cancers of clinically early stage.

A 42-year-old woman presented with bowel obstruction and was admitted to our hospital. She had a past history of bowel obstruction 2 years earlier. On abdominal contrast enhanced CT, a high-density tumor around the ileum causing bowel obstruction was found. We performed laparoscopic surgery and resected the ileal tumor 15 cm proximal to the ileocecal valve. The gross appearance of the tumor showed intestinal stenosis with dense fibrosis. Histopathological findings revealed ileal endometriosis with endometrial tissue infiltration to the ileal muscularis propria and mesenteric adipose tissue.

Although bowel obstruction due to intestinal endometriosis is rare, this must be kept in mind as a cause of bowel obstruction in young and middle-aged women. According to the Japanese literature, 19 cases of laparoscopic surgery for small intestinal endometriosis have been reported previously, and this procedure has demonstrated quite favorable outcomes.

Laparoscopic surgery is one of the beneficial treatments for intestinal endometriosis.

An 81-year-old woman was urgently taken to a former hospital because of anorexia. A 60-mm submucosal tumor was found in the rectum, and she was referred to our hospital. A mass was palpated 5 cm from the anal margin by rectal examination. A tumor with a nonuniform contrast effect of 59 × 51 mm in size was found in the lower rectum by contrast-enhanced CT examination, and lymph node enlargement with large axis of less than 12 mm was found around the tumor. An elastic hard submucosal tumor was noted on lower endoscopy. Spindle-shaped cells were observed in the biopsy specimen from the tumor, and were positive for S-100 protein, and negative for c-kit, CD34, SMA, and Desmin, according to immunohistochemistry. Based on the pathological diagnosis, the patient was diagnosed with rectal schwannoma. We performed laparoscopic low anterior resection with lymphadenectomy because lymph node enlargement was noted on the image and malignant cases have been reported. Pathological examination showed schwannomas with no lymph node metastasis or malignant findings. We report this case of rectal schwannoma accompanied by swollen lymph nodes with a review of the literature.

We report a case of locally far-advanced rectal cancer resected by laparoscopic surgery after colonic stent insertion and neoadjuvant chemotherapy. A 67-year-old man with a complaint of anorexia and weight loss visited our hospital in July 2019.

CT revealed a huge rectal tumor. Lower gastrointestinal endoscopy showed circumferential stenosis due to rectal cancer. Insertion of a self-expanding metallic stent for obstructive rectal cancer alleviated the patient's symptoms quickly．Six courses of neoadjuvant chemotherapy (mFOLFOX6) were administered. After chemotherapy, the tumor was markedly reduced and it was considered that the tumor could be radically resected, so laparoscopic surgery was performed. Combination therapy with colonic stenting and neoadjuvant chemotherapy can be an effective treatment for obstructive rectal cancer. It was possible to secure a circumferential resection margin (CRM). This case is considered to be one of the therapeutic strategies for locally advanced rectal cancer.

Introduction: After endoscopic mucosal dissection (ESD), several percent of cases show recurrence even in the absence of any common risk factors.

Case: A female in her 70s. We performed ESD for a laterally spreading tumor of the lower rectum. The pathological finding was 42×34 mm, tubular adenocarcinoma, well differentiated type to moderately differentiated type, pT1a (SM 200μm), ly0, v0, pHM0, pVM0, BD 1 without indications for additional resection. However, local recurrence was found 6 years later and robot-assisted abdominoperineal resection was performed. The pathological finding was compatible with local recurrence.

Discussion: Efforts are still under way to add new factors to the criteria for additional resection. One of them was suggested to be positive MUC1 which was noted in the present case. In addition, recurrence is said to be significantly more common in tumors larger than 20 mm in diameter. It was reported that some cases recurred 6 or 7 years after curative ESD for T1 colorectal cancer.

Conclusion: We experienced a case of recurrence 6 years after curative ESD for T1a lower rectal cancer without any common risk factors. Long-term follow-up after curative ESD for T1 rectal cancer is required.

The patient was an 85-year-old man who was admitted to our hospital because of right lower abdominal pain. Chest and abdominal CT showed retroperitoneal emphysema, pneumomediastinum and wall thickening at the ascending colon. We performed a right colectomy with lymphadenectomy under a diagnosis of obstructive colon cancer. During the laparotomy, retroperitoneal emphysema and emphysema in the mesentery of the right colon and the gastrocolic ligament were found.

The resected specimen revealed penetration to the mesenteric side at the ulcer floor of a type 2 tumor. The histopathological finding was well differentiated tubular adenocarcinoma, pT3N0M0 Stage IIa. The postoperative course was uneventful and the patient was discharged on the thirteenth postoperative day. Twenty-six cases of colorectal perforation with pneumomediastinum have been reported in Japan. We present our case with a review of the literature.

The patient was a 79-year-old female who underwent laparoscopic left hemicolectomy and D3 dissection with functional end-to-end anastomosis (FEEA) for transverse colon cancer. It was histopathologically diagnosed as moderately differentiated adenocarcinoma, T3 (SS), N1, M0, stage IIIa, according to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma, 8th edition. Nine months later, liver metastasis appeared and partial hepatectomy was performed. One year later, lung metastasis appeared and partial pulmonary resection was performed. Six years later, anticoagulant therapy was started because of DVT. Six years and 7 months later, she developed bloody stool and anemia; colonoscopy revealed recurrence of anastomotic type 3 tumor along the staple line, and biopsy revealed moderately differentiated adenocarcinoma, necessitating laparoscopic partial colon resection involving the anastomotic region. Pathological examination showed a similar histological type and tumor development from the staple, suggesting implantation metastasis. No relapse has been reported for 14 months after the operation. It is important to establish more effective measures for FEEA which has a high rate of anastomotic recurrence.